Psychiatry International

Background: Major depressive disorder (MDD) severely impairs quality of life (QoL), yet contextual constraints such as perceived time availability for self-care remain underexplored in low- and middle-income countries. This study evaluated multidimensional QoL and identified its independent correlates among outpatients with MDD in Ho Chi Minh City, Vietnam. Methods: A cross-sectional study was conducted among 290 outpatients with MDD on stable antidepressant therapy. Subjective QoL was measured using the WHOQOL-BREF, and depressive severity using the Quick Inventory of Depressive Symptomatology–Self Report (QIDS-SR16). Four domain-specific multivariable linear regression models applying robust standard errors were constructed. Results: Physical (45.2 ± 12.1) and Psychological (46.3 ± 12.7) QoL were most severely compromised. Depressive symptom severity was the strongest independent negative predictor across all four domains (p < 0.001). Lower perceived economic status predicted poorer psychological, social, and environmental QoL. Notably, severe perceived time constraint (“No time” for self-care) independently predicted lower Environmental QoL (β = −10.21, SE = 4.53, p = 0.025) after controlling for economic status and depression severity. Outpatients diagnosed within one year reported lower physical, psychological, and environmental QoL compared to those with 1–5 years of illness. Conclusions: Depressive severity is the most consistent correlate of QoL in Vietnamese outpatients with MDD, whereas perceived time availability for self-care exerts a domain-specific association with Environmental QoL. Comprehensive outpatient care should integrate symptom reduction with lifestyle-oriented guidance and psychosocial support. Full article

Background/Objectives: Various psychological and sociodemographic factors are strongly associated with shopping addiction in different populations. To date, the relationships between these variables have not been fully clarified. European data indicate a rise in shopping addiction among adults over the past two decades, but population-based epidemiological studies in Central and Eastern Europe, including Croatia, remain scarce. This study was conducted to examine the prevalence of shopping addiction and its related factors in Croatian adults. Methods: A cross-sectional online survey was conducted, with data collected via Google Forms from February to April 2024. An anonymous questionnaire covering sociodemographic data, the Bergen Shopping Addiction Scale (BSAS), and the Rosenberg Self-Esteem Scale (RSES) was self-administered by participants recruited using snowball sampling of Croatian adults. Results: The study included 715 participants from all Croatian regions. In the present sample, 14.3% of participants met the BSAS ≥ 12 cutoff, indicating probable and problematic shopping addiction. The BSAS score was significantly higher among females (p = 0.008), high school and university students (p = 0.048), and young adults aged 18–25 years (p = 0.042). Most participants reported average self-esteem (68.0%), while 31.2% and 0.8% had low and high self-esteem, respectively. BSAS scores correlated positively with RSES scores (ρ = 0.225; p < 0.001), while age was negatively correlated with both BSAS (ρ = −0.147; p < 0.001) and RSES (ρ = −0.356; p < 0.001) scores. After controlling for age and sex, the correlation between BSAS and RSES scores remained significant: partial rho = 0.103 and p = 0.006. Conclusions: Shopping addiction was prevalent in the studied population and was associated with specific sociodemographic characteristics and self-esteem levels, highlighting the need for targeted preventive strategies and further research into its underlying mechanisms. Full article

Bailan (摆烂), meaning “to give up and let things rot,” has emerged among Chinese youth as a cultural expression of disillusionment, withdrawal, and resignation in response to intense academic, occupational, and socioeconomic pressures. However, its conceptual boundaries and clinical relevance remain unclear. This narrative review examines Bailan as an emerging cultural idiom of distress, its sociocultural and psychological characteristics, and its potential relationship with psychopathology. Relevant English- and Chinese-language literature was identified through searches of major academic databases and narratively synthesised. The review indicates that Bailan may function as coping, cultural resistance, ironic self-expression, or communication of distress. Although it overlaps conceptually with learned helplessness, anhedonia, demotivation, and social withdrawal, current evidence does not establish Bailan as a psychiatric diagnosis or validated prodromal marker. Nevertheless, persistent Bailan-related disengagement accompanied by subjective distress, functional deterioration, or other psychiatric symptoms may warrant clinical assessment. Bailan should therefore be interpreted according to the individual’s cultural context, intention, duration of disengagement, and level of functioning. Culturally sensitive assessment may reduce both assumption and missed psychological distress. Qualitative, cross-cultural, and longitudinal studies are needed to define the construct and determine whether Bailan-related patterns predict subsequent mental health outcomes. Full article

The Hierarchical Taxonomy of Psychopathology (HiTOP) has gained substantial empirical support as a dimensional model for understanding severe psychopathology. However, the integration of the Level of Personality Functioning (LPF) into this framework remains debated, and its specific contribution to understanding psychological symptoms is less extensively studied. This study examined the associations among impairments in personality functioning (self and interpersonal), maladaptive personality traits, alexithymia, and emotion regulation with psychological symptoms in a transdiagnostic sample of severe psychiatric inpatients. Ninety-three patients from a comprehensive mental health facility providing sub-acute care and long-term rehabilitation completed the SCL-27 for symptom assessment, LPFS-BF for personality functioning, PID-5-BF for maladaptive traits, the Toronto Alexithymia Scale and the Cognitive Emotion Regulation Questionnaire for emotion dysregulation. Standard and hierarchical multiple regression analyses were conducted to examine unique incremental associations across symptom domains. Self and interpersonal functioning measures showed strong associations with all symptom scales, while alexithymia was also broadly associated with symptom severity in initial models. After accounting for emotion dysregulation variables, interpersonal functioning remained uniquely associated with dysthymic, social phobia, and mistrust symptoms, while self-functioning associations were no longer evident for vegetative, depressive, and agoraphobic symptoms. These findings demonstrated that core personality functioning impairments accounted for psychiatric symptom expression beyond maladaptive traits alone. The results supported greater integration of personality functioning into dimensional models of psychopathology like HiTOP. Full article

Child maltreatment (CM) has been associated with adverse outcomes in bipolar disorder (BD), although evidence from Chile remains limited. We examined associations between CM, emotion dysregulation, impulsivity, and neurocognition in euthymic individuals with BD type I. CM, emotion dysregulation, impulsivity, and neurocognition were assessed using the Childhood Trauma Questionnaire-Short Form, Difficulties in Emotion Regulation Scale, Barratt Impulsiveness Scale-11, Montreal Cognitive Assessment (MoCA), and Digit Symbol Substitution Test (DSST), respectively. Associations were examined using Spearman correlations and multivariable linear regression models adjusted for age and sex, with false discovery rate (FDR) correction for multiple testing. In adjusted analyses, emotional abuse and emotional neglect were associated with higher total emotion dysregulation scores (β = 1.95, FDR-adjusted p = 0.011; and β = 2.47, FDR-adjusted p = 0.001, respectively). Emotional neglect was also associated with higher total impulsivity (β = 1.19, FDR-adjusted p = 0.026), while physical abuse was associated with lower MoCA scores (β = −0.28, FDR-adjusted p = 0.0498). No CM dimension was significantly associated with DSST performance after FDR correction. Secondary adjusted analyses showed that emotional neglect was associated with greater emotional rejection and emotional interference. Exploratory bivariate analyses also identified associations between emotional and physical neglect and a higher number of lifetime suicide attempts. Although several differences emerged in sensitivity analyses using high/low CM categories, none remained significant after FDR correction. Emotional forms of CM were particularly associated with emotion dysregulation in euthymic individuals with BD type I, while associations with impulsivity and neurocognition were more limited. Larger longitudinal studies are needed to clarify the temporal and potentially mechanistic relationships between CM and psychological functioning in BD. Full article

Background: Common mental health conditions are associated with increased mortality, but longitudinal evidence from low- and middle-income countries (LMICs) remains limited. We aimed to examine whether baseline depression and anxiety were associated with all-cause mortality over 16 years in rural Nepal. Methods: We conducted a 16-year prospective cohort study in rural Nepal. At baseline in 2000, 316 adults were assessed using Nepali-validated versions of the Beck Depression Inventory (BDI; cut-off ≥ 20) and Beck Anxiety Inventory (BAI; cut-off ≥ 17). In 2016, 297 participants were successfully followed up; 46 had died and verbal autopsy data were available for 40 deaths. Logistic regression models were adjusted for gender, ethnicity, age, education, and income. Results: Among the 297 participants followed up, 34% of participants scored above the cut-off for depression, 27% for anxiety, and 17% for both at baseline. Forty-six participants (15%) died during follow-up. Among the 40 deaths with completed verbal autopsy, chronic respiratory disease was the leading cause of death (23/40, 57.5%). Adjusted odds of mortality were higher among participants scoring above the cut-off for depression (OR 2.34, 95% CI 1.01–5.53), anxiety (OR 3.49, 95% CI 1.27–10.15), and comorbid depression and anxiety (OR 5.27, 95% CI 1.65–17.61). In the comorbidity-adjusted model, women had lower odds of mortality (OR 0.22, 95% CI 0.07–0.61) and Dalit participants had higher odds (OR 4.62, 95% CI 1.44–16.96). Conclusions: Anxiety and comorbid depression and anxiety were associated with higher mortality over 16 years. Depression alone was associated with mortality in logistic regression, but this association was not statistically significant in sensitivity analyses and should therefore be interpreted cautiously. Full article

Objective. Public safety personnel (PSP; e.g., police, firefighters, paramedics, correctional workers, and communications officials) face elevated risks of mental health concerns, including suicidal ideation and behaviours. Well-validated cognitive and interpersonal theories of suicide emphasize the roles of hopelessness, belongingness, traumatic exposures, and burdensomeness; however, the integration with symptom-level processes of posttraumatic stress remains limited. This study examined the relationships between posttraumatic stress symptoms (PTSSs), hopelessness, and suicidal ideation in relation to suicidal contemplation in a large sample of PSP. Method. Data were collected between September 2016 and January 2017 from 1259 Canadian public safety personnel, including 623 who endorsed suicidal contemplation and 636 who did not. Participants completed validated self-report measures of posttraumatic stress symptoms (PCL-5), depression symptoms, including hopelessness and suicidal ideation (PHQ-9), and trauma exposure (LEC-5). Separate partial correlation networks were estimated for personnel with and without suicidal thoughts using regularized graphical models. Centrality was assessed with expected influence, networks were compared using the Network Comparison Test, and a directed acyclic graph was constructed to examine conditional dependency patterns. Results. Networks for personnel with suicidal contemplation showed greater overall connectivity. Comparison tests indicated that network structure and centrality differences were not statistically significant between groups. Descriptively, several trauma-related symptoms appeared somewhat more central in the contemplation network, although centrality differences were not statistically significant. Directed acyclic graph modelling identified conditional dependence patterns linking hopelessness and suicidal ideation, with PTSSs such as upsetting reminders and detachment also appearing in the model. Conclusions. Findings align with elements of cognitive and interpersonal theories of suicide while extending them to posttraumatic stress processes in PSP. The results provide exploratory hypotheses concerning hopelessness and trauma-related symptoms for future longitudinal and intervention research, while recognizing that the findings reflect cross-sectional, pre-pandemic associations. Full article

Developmental Language Disorder (DLD) and developmental dyslexia are among the most prevalent neurodevelopmental disorders affecting children’s language, literacy, academic achievement, and social participation. Although traditionally conceptualised as distinct disorders of oral and written language, respectively, increasing evidence suggests substantial overlap in their underlying developmental mechanisms while preserving distinguishable clinical phenotypes. This critical narrative review synthesises evidence from epidemiological, longitudinal, cognitive–linguistic, behavioural genetic, and clinical studies examining the relationship between DLD and developmental dyslexia. Particular attention is given to prevalence, comorbidity, shared risk factors, developmental trajectories, and the implications of categorical versus dimensional models for clinical assessment and intervention. The evidence indicates that DLD and developmental dyslexia share multiple cognitive and linguistic liabilities, including weaknesses in phonological processing, verbal memory, processing efficiency, and broader oral language abilities. These vulnerabilities interact with genetic, environmental, educational, and orthographic influences, producing heterogeneous developmental profiles and frequent comorbidity. At the same time, each disorder retains characteristic clinical features that justify their continued diagnostic distinction. The available evidence supports a hybrid conceptualisation in which DLD and developmental dyslexia are viewed as distinct but partially overlapping neurodevelopmental disorders within a multidimensional language–literacy framework. Building on previous work concerning diagnostic differentiation, comorbidity, and shared developmental mechanisms, this review integrates epidemiological, developmental, cognitive–linguistic, genetic, cross-linguistic, and clinical evidence within a clinically oriented two-dimensional language–literacy framework intended to generate testable hypotheses and inform future research on assessment and intervention. Full article

Armed conflict is a well-established risk factor for children’s mental health, yet young children remain underrepresented in research on mental health among children affected by conflict in the Gaza Strip. This systematic review synthesized evidence on the relationship between war exposure and mental health outcomes among children aged 0–8 years in the Gaza Strip, drawing on studies published between 2000 and 2026 to compare findings across conflicts preceding and following the October 2023 escalation. Following PRISMA 2020 guidelines, five databases (Scopus, Web of Science, ERIC, PubMed, and PsycINFO) were searched, yielding 220 records. After screening and full-text assessment, seven reports representing six independent samples (N = 309–11,646) met the eligibility criteria; all included studies were conducted in the Gaza Strip, and no eligible studies from the West Bank or East Jerusalem were identified. Methodological quality, assessed using the JBI Critical Appraisal Checklist, ranged from low to high. Across the outcomes examined, including post-traumatic stress, anxiety, depression, and broader psychosocial and behavioral functioning, greater trauma exposure was generally associated with poorer outcomes. Reported PTSD estimates varied substantially across studies and assessment approaches, ranging from 6% in a preschool sample to 57.8% in a broader sample, with the latter estimate decreasing to 15.6% under a stricter DSM-5 diagnostic algorithm. These differences likely reflect, at least in part, variation in age range, assessment instruments, and diagnostic thresholds. Caregiver mental health was consistently associated with child outcomes and, in some studies, showed stronger associations than children’s reported trauma exposure. Household socioeconomic disadvantage was also associated with poorer outcomes, while findings regarding sex differences in internalizing symptoms were inconsistent; boys were more frequently reported to exhibit externalizing problems. All included studies were cross-sectional and conducted in Gaza, limiting causal inference and geographic generalizability. These findings indicate that supporting children’s mental health in the context of war cannot be separated from supporting the caregivers who raise them and underscore the urgent need for longitudinal and intervention-focused research addressing the ongoing consequences of the 2023–2025 war. Full article

(1) Background: Women in the peripartum period are at increased vulnerability to the development or worsening of mental disorders. However, data from specialized psychiatric settings in Southeast Europe on this topic remain limited. In this study, we assessed the distribution of perinatal mental health disorders, diagnostic changes, hospitalizations, obstetric complications, and breastfeeding among women treated at the Perinatal and Reproductive Psychiatry Unit in Belgrade, Serbia. (2) Methods: A retrospective review of medical records from 287 patients (2015–2024), including sociodemographics, ICD-10 diagnoses, hospitalizations, obstetric complications, and breastfeeding data, was performed. (3) Results: The mean age of the women in this cohort was 33.1 ± 5.6 years. Mood disorders (F30–F39) were most common (39.6% before, 42.2% during, and 32.1% after pregnancy), followed by neurotic and stress-related disorders (F40–F48). Postpartum F50–F59 diagnoses (especially mental and behavioral disorders associated with the puerperium, not elsewhere classified—F53) rose significantly (p < 0.001). Overall, 38.7% of patients had at least one psychiatric hospitalization; hospitalization was recorded before pregnancy in 30.0%, during pregnancy in 5.9%, and postpartum in 6.6%, with overlap between periods. Leading obstetric complications were emergency cesarean (1.0%) and fetal loss (1.4%). Only 41.3% of the women whose data were available breastfed (mean 4.7 months). (4) Conclusions: Mood disorders predominate in specialized psychiatric perinatal care. The results of this study indicate the frequency of perinatal mental disorders and the need for both outpatient and inpatient treatment. It is, therefore, essential to continue developing mental health care systems for women in Serbia and to provide ongoing education for health professionals in order to ensure timely diagnosis and treatment of pregnant and postpartum women. Full article

Mental disorders are a leading cause of global disability, and environmental characteristics are increasingly recognized as relevant to mental health. Although green-space exposure has been associated with psychological benefits, the contribution of biodiversity-related exposures remains insufficiently characterized. This scoping review mapped quantitative associations between biodiversity-related exposures and mental health. Following PRISMA-ScR guidance, PubMed (MEDLINE), PsycINFO, and Embase were searched without date restrictions, supplemented by reference screening. English- or French-language quantitative studies were included when biodiversity was assessed using direct objective indicators, perceived biodiversity, or biodiversity-related ecological proxies and mental health outcomes were reported. Twenty-eight studies published between 2007 and 2024 met inclusion criteria, encompassing observational, experimental, and quasi-experimental designs across several geographic regions. Biodiversity-related exposures were generally associated with greater psychological well-being, positive affect, and restoration, and with lower stress-related outcomes; some studies also reported fewer depressive and anxiety symptoms. Perceived biodiversity showed more consistent associations with psychological outcomes than direct objective measures. Evidence for physiological and clinical outcomes was limited, and no study used formal psychiatric diagnostic assessments. Overall, biodiversity-related exposures may be relevant to mental health, but heterogeneous measures and predominantly cross-sectional evidence limit causal inference and support the need for standardized metrics and longitudinal or experimental studies. Full article

Background/Objectives: Digital technologies are increasingly embedded in children’s everyday lives, yet problematic Internet use (PIU) remains conceptually heterogeneous and has been studied mainly in adolescents. This narrative review aimed to synthesize recent empirical evidence on how Internet use and its problematic manifestations are conceptualized and measured among primary school children and to identify individual and contextual factors associated with the specific Internet-related outcomes assessed from a socioecological perspective. Methods: This narrative review was informed by focused, non-exhaustive searches conducted in APA PsycInfo, Web of Science Core Collection, and PubMed for recent quantitative empirical research published between 2021 and 2026 involving primary school populations. Eighteen studies considered directly relevant to the review objectives constituted the central body of literature for the descriptive and interpretive narrative synthesis. Results: The studies used heterogeneous terminology, ranging from general or risky Internet use to problematic smartphone and video game use, Internet addiction, and Internet gaming disorder. Of the 18 included studies, 12 used cross-sectional designs, limiting the ability to draw causal inferences from the reported associations. Higher levels or a greater likelihood of problematic use were associated with family conflict, insecure attachment, maladaptive parenting practices, parental technology dependence, socioemotional difficulties, externalizing problems, peer victimization, deviant peer affiliation, and intensive recreational digital use. Positive parent–child relationships, parental supervision, authoritative parenting, parental digital competence, positive peer communication, resilience, traditional games, and a positive school climate were associated with lower levels or a lower likelihood of the corresponding Internet-related outcomes. One of the studies concerning traditional games assessed general Internet use rather than PIU. Within the focused body of literature, only one study provided school-level evidence, and none examined community-level factors. Conclusions: PIU may serve as an umbrella term for organizing heterogeneous Internet-related constructs, provided that the conceptual and methodological distinctions among the specific outcomes are preserved. The reported associations span individual and contextual domains, but the predominance of cross-sectional evidence prevents causal interpretation. These findings may inform hypotheses and priorities for developmentally appropriate prevention; however, they should not be regarded as demonstrating the effectiveness of particular interventions. Future research should employ longitudinal designs and more standardized terminology and validated assessment instruments. Full article

Background: Schizophrenia is a debilitating disorder that exacts a heavy burden on sufferers and carers alike. Despite improvements in neuroimaging techniques in the past decades, schizophrenia has lacked a clear definition at the neuroanatomical level. The presence of diagnostic markers may lead to breakthroughs with our current phenomenological approach to schizophrenia, assisting with diagnosis and monitoring of the disease. Prior study findings suggest structural retinal changes in schizophrenia, including retinal-layer thinning and microvascular changes. Aim: We aim to evaluate whether retinal imaging, in combination with machine-learning approaches, can facilitate diagnostic classification of schizophrenia. Furthermore, we characterise retinal structural features in individuals with schizophrenia compared with healthy controls, and examine whether these retinal measures are associated with disease status, clinical severity, functional outcomes, and other key clinical variables. Method: This study recruited 64 individuals with schizophrenia and 64 healthy controls. Participants in the schizophrenia group completed standardized clinical rating scales to assess symptom severity and functional status. Additional clinical variables, including demographic characteristics, duration of untreated psychosis, and antipsychotic medication dosage, were recorded. All participants underwent fundus photography, and retinal images were processed using the Automated Retinal-Imaging Analysis (ARIA) system developed at the Chinese University of Hong Kong (CUHK). Extracted retinal parameters were used to train machine-learning models to classify schizophrenia cases versus controls. Using a cross-sectional design, we compared retinal characteristics between groups while adjusting for relevant confounders, and evaluated associations between retinal measures and clinical variables within the schizophrenia cohort. Results: Our machine-learning model successfully distinguished individuals with schizophrenia from healthy controls, achieving high sensitivity (96.9%) and specificity (92.2%). Consistent with prior literature, we observed reductions in some measures of retinal thickness in the schizophrenia group, along with some novel alterations in venular microvascular structure. No associations between retinal measurements and symptom severity or illness-related variables were statistically significant. Conclusions: The strong discriminatory performance of our machine-learning (ML) model underscores the potential value of ML-based retinal analysis as an adjunct to existing diagnostic and risk-stratification approaches for schizophrenia. Our findings suggest retinal-layer alterations in schizophrenia and novel microvascular changes that have not been examined in earlier work. Together, these results highlight promising directions for future large-scale investigations into retinal biomarkers in schizophrenia. Full article

Background: Medical students experience substantially higher rates of anxiety and depressive symptoms than similarly aged members of the general population. Academic, financial, and social pressures, together with concerns about stigma, may discourage timely engagement with conventional mental health services. Artificial intelligence (AI)-enabled conversational agents delivering cognitive behavioural therapy (CBT) may provide an accessible and scalable form of psychological support, although evidence among international medical students remains limited. Objective: This study evaluated the feasibility and preliminary clinical effectiveness of an AI-supported conversational agent delivering CBT-based interventions for reducing symptoms of anxiety and depression in international medical students. Methods: A two-week pilot randomized feasibility trial was conducted among international medical students with clinically relevant symptoms of anxiety and/or depression. Participants were randomized to either an AI conversational CBT intervention or a psychoeducational self-help control. Feasibility and changes in anxiety and depressive symptoms were assessed following the intervention. Results: Of 228 screened students, 138 were randomized, with 74.6% retained at two weeks. Study completion was substantially higher in the intervention group. ANOVA demonstrated a significant effect of the intervention on post-intervention depressive symptoms, with participants receiving the conversational agent reporting significantly lower scores than controls. Anxiety symptoms also showed a significant intervention effect, with moderate-to-large treatment effects observed after two weeks. Conclusions: AI-supported conversational CBT appears feasible and acceptable for international medical students and may reduce short-term symptoms of anxiety and depression. The significant ANOVA findings provide preliminary evidence of clinical effectiveness. Larger multicentre randomized controlled trials with longer follow-up are warranted to confirm these findings and determine the potential role of AI-based interventions within university mental health services. Full article

Background: Mental Health Literacy (MHL), originally conceptualised by Jorm as knowledge and beliefs that facilitate the recognition, management, and prevention of mental disorders, has expanded to encompass Positive Mental Health Literacy (PMHL), incorporating constructs such as well-being, resilience, and flourishing. This conceptual expansion has raised concerns regarding conceptual ambiguity, redundancy with established well-being science, and the blurring of the distinction between knowledge and outcomes. Methods: A bibliometric analysis was conducted to map the conceptual evolution of the field. Records were retrieved from Web of Science, Scopus, MEDLINE (via PubMed), and CINAHL (via EBSCO), harmonised, deduplicated, and restricted to articles and reviews, yielding a corpus of 2443 documents published between 2000 and 2026. The data were analysed using the bibliometrix package and VOSviewer. Co-citation analysis and bibliographic coupling were not performed, as complete cited-reference data were unavailable; the keyword co-occurrence, thematic map, and thematic evolution analyses were conducted on a merged Web of Science and Scopus subset (n = 2059) rather than on the full corpus (n = 2443). Results: Scientific output was heavily concentrated in recent years, with approximately 72% of the corpus published from 2020 onwards. The field was dominated by a foundational Australian tradition centred on Jorm and the Mental Health First Aid network. Keyword co-occurrence analysis identified two asymmetric thematic poles: a dominant classical cluster organised around stigma, help-seeking, and disorder recognition, and a smaller, emerging cluster focused on well-being and mental health promotion. The most highly cited publications belonged to the classical core. Conclusions: These findings indicate that the expansion towards PMHL has diversified the periphery of the field without displacing its conceptual core, while also revealing terminological overlap that warrants clearer conceptual boundaries and more rigorous construct operationalisation. Full article

Background: Modern-type depression (MTD), first described in Japan, reflects a sociocultural form of depression characterized by avoidance of social roles, complaint tendencies, and low self-esteem. While increasingly recognized across Asian societies, no Malay-language adaptation of the TACS-22 has previously undergone psychometric evaluation. Objectives: This study aimed to translate and culturally adapt the Tarumi’s Modern-Type Depression Trait Scale (TACS) into Malay and to evaluate the reliability, factorial structure, discriminant validity, and convergent associations of the Malay version among Malaysian adults. Methods: Following standardized forward and backward translation and expert review, the TACS-22-Malay was administered to convenience sample of 250 predominantly young Malaysian adults together with the Malay Depression, Anxiety, and Stress Scale. Internal consistency was examined using Cronbach’s alpha, ordinal McDonald’s omega, and the Greatest Lower Bound (GLB). Because the TACS items comprise five ordered-response categories and multivariate nonnormality was present, the primary confirmatory factor analysis used the weighted least squares mean and variance-adjusted estimator with ordered indicators. The complete 22-item-correlated three-factor model was evaluated, with robust maximum likelihood and conventional maximum likelihood models used as sensitivity analyses. A one-factor model was also examined. Convergent associations were evaluated using Spearman’s ρ with bootstrap confidence intervals. Results: Internal consistency was high for the total score (alpha = 0.804, ordinal omega = 0.839, GLB = 0.877), but varied across Avoidance of Social Roles (alpha = 0.617, omega = 0.677), Low Self-Esteem (alpha = 0.711, omega = 0.760), and Complaint (alpha = 0.412, omega = 0.496). The primary three-factor WLSMV model showed poor fit, chi square (206) = 794.922, p < 0.001, CFI = 0.587, TLI = 0.537, RMSEA = 0.117, 90% CI [0.110, 0.125], SRMR = 0.108, and produced an inadmissible latent covariance matrix. Latent correlations were 0.748, 0.959, and 1.050, with the Low Self-Esteem and Complaint correlation exceeding 1. The one-factor WLSMV model also fit poorly. Robust and conventional maximum likelihood sensitivity analyses led to the same substantive conclusion. All TACS scores were positively associated with DASS 21 Depression, Anxiety, and Stress, with Spearman’s ρ ranging from 0.235 to 0.644. Conclusions: The Malay TACS-22 demonstrates useful internal consistency at the total score level and meaningful associations with psychological distress, but the hypothesized three-factor measurement model was not supported and discriminant validity between factors was inadequate. The poor fit of the one-factor model also indicates that high total score reliability should not be interpreted as evidence of unidimensionality. The present findings therefore support the Malay version as a provisional adaptation requiring further item refinement and independent validation rather than as a fully validated instrument. Full article

Autism interventions are commonly evaluated at the level of treatment packages and intervention fidelity, whereas the therapist’s moment-to-moment embodied and interactional contribution is less often specified or directly measured. This work advances a more specific, testable hypothesis: therapist characteristics may be clinically relevant environmental inputs within a therapeutic dyad. We define co-regulation as a reciprocal, time-varying process in which each partner’s signals and responses are contingently adjusted in relation to the other’s state. This process is distinct from therapist-driven regulation, autonomic synchrony, or treatment response. We define a privileged environment as a recurrent therapeutic context whose observable interpersonal properties—such as predictability, contingency, sensory intensity, and responsiveness—are deliberately individualized to support a specific child’s participation and learning. Existing intervention studies demonstrate treatment-associated behavioral and neural changes, but generally do not isolate therapist autonomic state, prosody, posture, respiration, or other embodied features as independent causal mechanisms. Accordingly, the model should be read as a framework for measurement and hypothesis testing. The article outlines candidate mechanisms, specifies moderators, and proposes designs capable of separating therapist-specific effects from intervention, child, and contextual influences. Full article

Mental health problems represent a growing public health burden, particularly in middle-income countries where population-based evidence remains limited. This study aimed to analyze the risk profiles and heterogeneity of symptoms compatible with depression, suicidal ideation, and panic in the adult population of Paraguay. A cross-sectional study was conducted using nationally representative data from the 2022 STEPS survey. The presence of symptoms compatible with depression, panic, and suicidal ideation was assessed using self-reported dichotomous screening questions. Associations with sociodemographic, behavioral, and clinical variables were analyzed using multivariate models, estimating adjusted odds ratios (aOR) with 95% confidence intervals, and the analyses accounted for the complex sampling design. The prevalence of symptoms compatible with depression was 35.8%, panic 22.4%, and suicidal ideation 8.0%. Higher odds were observed in women, younger age groups, urban residents, and individuals reporting daily smoking as well as those with diabetes mellitus. Associations varied across outcomes, reflecting heterogeneous risk patterns. Symptoms compatible with depression, panic, and suicidal ideation are highly prevalent and unequally distributed in the adult population of Paraguay. These findings highlight the need for targeted prevention strategies, early detection, and the integration of mental health into public health and noncommunicable disease policies and management. Full article

Fathers play a vital role in caring for children with Autism Spectrum Disorder (ASD). Fathers of children with ASD today have moved far beyond the “occasional helper” role. They are deeply involved in daily caregiving routines, supporting their families financially and emotionally. The involvement of the father in raising a child with ASD reduces stress levels for both parents and strengthens family ties. The study explored and described the roles that fathers play in the care of children with ASD. A qualitative, explorative, descriptive, and contextual research design was used to gain a detailed understanding of the role’s fathers play in the care of children with ASD. Non-probability purposive sampling was used to recruit 15 fathers of children with ASD. Data were collected through semi-structured interviews and analysed using Tesch’s eight data analysis steps. The findings revealed that fathers play a variety of roles in the care of their children with ASD. These include participating in meeting the needs of their children with ASD, protecting them from harm, promoting their emotional well-being, and supporting the overall operation of the family. The experiences of fathers in this study also reflect the difficulties of raising a child with ASD, such as financial expenses, safety concerns, and community stigma. It is necessary to create father-inclusive guidelines in maternal and child health services formally to integrate fathers into every aspect of children’s care, switching from a mother-centred approach to a family-centred one. As a result, fathers will routinely participate in the consultation, decision making, and treatment of their children with ASD. Full article